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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313614186
Report Date: 07/10/2026
Date Signed: 09/24/2026 01:32:23 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2026 and conducted by Evaluator Stephanie Piring
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20260513160246
FACILITY NAME:HOLY CROSS LUTHERAN PRESCHOOLFACILITY NUMBER:
313614186
ADMINISTRATOR:OCTAVIA WILLIAMSFACILITY TYPE:
850
ADDRESS:4701 GROVE STREETTELEPHONE:
(916) 624-2123
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:126CENSUS: 53DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kim Lunsford and Octavia WilliamsTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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9
Staff engage in verbal altercations in the presence of day care children
INVESTIGATION FINDINGS:
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13
This is an amended version of a report, originally created on 7/10/26. This LIC9099 supercedes the original finding delivered on 7/10/26.

On Friday, July 10, 2026, Licensing Program Analysts (LPA) Stephanie Piring met with Facility Representative, Kim Lunsford and Octavia Williams, for the purpose of delivering complaint investigation findings. During todays visit, LPA observed 42 preschool age children children being supervised by 7 staff on the play ground during water play and 11 preschool age children in classroom 6 being supervised by 2 staff.

It was alleged that Staff engage in verbal altercations in the presence of day care children. During the course of the investigation, LPA made observations, conducted interviews and reviewed relevant documentation. Interviews with staff, and written statements revealed a verbal altercation occurred between two staff members on the play ground; however LPA swas not able to determine if the altrecation happened in the presence of children or parents. Based on staff interviews and written statements, although the allegations may have happened, there is not a preponderance of evidence to prove the allegation; therefore, the allegations are unsubstantiated. Exit interview was conducted and report was reviewed with Facility Representatives. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 03-CC-20260513160246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: HOLY CROSS LUTHERAN PRESCHOOL
FACILITY NUMBER: 313614186
VISIT DATE: 07/10/2026
NARRATIVE
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This is an amended version of a report, originally created on 7/10/26. This LIC9099 supersedes the original finding delivered on 7/10/26.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 03-CC-20260513160246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOLY CROSS LUTHERAN PRESCHOOL
FACILITY NUMBER: 313614186
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
07/13/2026
Section Cited
CCR
101223(a)
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This is an amended version of a report, originally created on 7/10/26. This deficiency was dismissed.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mai Lor
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/13/2026 and conducted by Evaluator Stephanie Piring
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20260513160246

FACILITY NAME:HOLY CROSS LUTHERAN PRESCHOOLFACILITY NUMBER:
313614186
ADMINISTRATOR:OCTAVIA WILLIAMSFACILITY TYPE:
850
ADDRESS:4701 GROVE STREETTELEPHONE:
(916) 624-2123
CITY:ROCKLINSTATE:CAZIP CODE:
95677
CAPACITY:126CENSUS: 53DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kim Lunsford and Octavia WilliamsTIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled day care children in a rough manner
Staff are using inappropriate forms of punishment
Staff are not meeting day care children's needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On Friday, July 10, 2026, Licensing Program Analysts (LPA) Stephanie Piring met with Facility Representative, Kim Lunsford and Octavia Williams, for the purpose of delivering complaint investigation findings. During todays visit, LPA observed 42 preschool age children children being supervised by 7 staff on the play ground during water play and 11 preschool age children in classroom 6 being supervised by 2 staff.

It was alleged that staff handled day care children in a rough manner, staff are using inappropriate forms of punishment, staff are not meeting day care children's needs . During the course of the investigation, LPA made observations, conducted interviews and reviewed relevant documentation. Interviews with staff, authroized representatives, and children did not reveal any instances where staff handled children in a rough manner, where inappropriate forms of punishment were used, or where childrens needs were not met. Interviews conducted failed to corroborate the allegations. Although the allegations may have happened, there is not a preponderance of evidence to prove the allegation; therefore, the allegations are unsubstantiated. Exit interview was conducted and report was reviewed with Facility Representatives. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Stephanie Piring
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4